Truro ER doctor sanctioned for subpar treatment

An emergency room doctor in Truro has been reprimanded for providing substandard care after he misdiagnosed a woman who had acute hepatitis and sent her home.

The College of Physicians and Surgeons sanctioned Dr. Justin Clark, who works at the East Hants Community Health Centre, after a March 20 complaint from the daughter of the woman treated at the health centre’s emergency department.

The elderly woman, who was not identified, was taken by ambulance to the ER sometime in early 2017, according to the college’s report on the incident released Monday. She was very weak and put into a treatment room where she was initially seen by another doctor, who felt her symptoms were likely side-effects of antibiotics the woman was taking for urinary tract infections.

After taking over the case, Clark reviewed test results such as urinalysis, blood tests and X-rays. He found no problems and said the woman should be taken off the antibiotics that appeared to be causing the side effects.

He told the family the patient was elderly, her health was declining and “there was nothing more that could be done in hospital,” the report said. “He stated that blood work came back ‘very good.’” But a family physician who saw the woman the next day said the blood work wasn’t good and she needed to return to hospital. The woman was seen by another doctor at the Truro emergency room, who admitted her after concluding that she had acute hepatitis. The doctor apologized to her that she’d been sent home.

The woman died in hospital the following week.

Clark told college investigators that he didn’t know how the abnormal blood tests did not come to his attention. “He is unsure whether another patient’s results were placed in the chart in error or if he reviewed the wrong report online,” the report said, noting Clark said an internal hospital review into procedures would be done as a result of the mistake.

While Clark told the college he did a brief physical exam of the woman, the family said they didn’t see him do one and college investigators said there was no documentation of a physical exam. The woman’s daughter told the college she was upset at the way Clark treated her mother and felt it was because of her age.

“The complainant believes Dr. Clark did not take her mother’s condition seriously and, whether she had lived longer or not, she could have at least had another comfortable night.”

The report noted Clark was remorseful. “I feel terrible about missing the blood work and especially how they felt I was dismissive of their loved one’s complaints,” he said in his response to the college. “I think I will use this experience to improve my care moving forward.”

He received three reprimands for: failing to perform and document an appropriate history and physical examination; failing to ensure thelaboratory results he ordered were appropriately reviewed before makingdecisions about the patient; and, inappropriately advising the family about comfort care given the limited assessment and knowledge of the patient.

The decision noted mitigating factors such as the fact that Clark is a young physician, and he had taken over the woman’s case from another doctor and was biased by the previous physician’s conclusion that the antibiotics were the problem.

While the sanction does not directly affect his ability to practise, “it forms part of Dr. Clark’s professional record and it will remain a part of his record as long as he’s in the profession,” said Dr. Gus Grant, registrar and CEO of the College of Physicians and Surgeons, in an interview Tuesday.

“This is a very serious matter for a physician . . . and I can see from Dr. Clark’s utterances the extent to which he took it seriously . . . and his contrition.”

The college’s investigating committee is made up of experienced doctors and members of the public, Grant said.

“When they examine a complaint they look at it whole, so I think it would be an unfair characterization simply to say that a diagnosis was missed. I think, rather, the conclusion of the committee that was consented to by Dr. Clark was that the care in a number of areas fell below the standards expected of the profession.”